Author + information
- Received August 5, 1994
- Revision received July 21, 1995
- Accepted August 1, 1995
- Published online January 1, 1996.
- Arturo Evangelista, MD**,
- Herminio Garcia-del-Castillo, MD,
- Teresa Gonzalez-Alujas, MD,
- Rosa Dominguez-Oronoz, MD,
- Armando Salas, MD,
- Gaieta Permanyer-Miralda, MD and
- Jordi Soler-Soler, MD, FACC
- ↵**Address for correspondence: Dr. Arturo Evangelista, Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
Objectives. This study sought to assess the reliability of biplanar transesophageal echocardiography in the diagnosis of ascending aortic dissection and to test the utility of M-mode information in the differential diagnosis of ascending aortic ultrasound artifacts and intimal flap images.
Background. Transesophageal echocardiography is a useful technique in the diagnosis of aortic dissection. However, ultrasound artifacts in the ascending aorta are an important limitation.
Methods. Transesophageal echocardiography was performed in 132 consecutive patients with clinically suspected aortic dissection. Two-dimensional and M-mode echocardiography and color Doppler were used to diagnose intimal flap and artifact images. Diagnoses were validated either anatomically or with reference techniques.
Results. The sensitivity and specificity of transesophageal echocardiography in the diagnosis of ascending aortic dissection were 96.8% and 100%, respectively. Ninety-three artifacts were observed in 56 (55%) of 101 patients without ascending aortic dissection. Two-dimensional echocardiography easily identified 74 artifacts (80%). Color Doppler showed no ascending flow abnormalities in 71% of artifact images. M-mode echocardiography showed three location and mobility artifact patterns related to the posterior wall of the aorta or the right pulmonary artery. In contrast, intimal flap movement showed no relation to the aortic wall movement in 25 cases (83%). Blind analysis of transesophageal echocardiographic study tapes underlined the utility of M-mode in the differential diagnosis. Ranges of sensitivity, specificity and positive predictive value (established by including doubtful results as either positive or negative) improved from 87.1–93.5% to 93.5- to 96.8%, from 85.1–94.1% to 99–100% and from 65.9–81.8% to 96.8–100%, respectively, with the inclusion of M-mode data.
Conclusions. Biplanar transesophageal echocardiography permits reliable diagnosis of ascending aortic dissection. Ultrasound artifacts are common, but assessment of the location and mobility of intraluminal images by M-mode echocardiography definitely improves diagnostic accuracy.
This study was supported in part by Direcci6 per a la Recerca i Docència de l'Hospital Universitari Vall d'Hebron (CR HG-07-92-70), Barcelona, Spain.
- Received August 5, 1994.
- Revision received July 21, 1995.
- Accepted August 1, 1995.
- American College of Cardiology